Cardiac Catheterization

Cardiac catheterization is a procedure that is done in the hospital. Some patients go home the same day after the procedure. Cardiac catheterization involves putting a catheter (thin tube) through either your groin or wrist and advancing it to the heart. A dye is injected in the blood vessels of the heart and an X–ray machine is used to see the flow of this dye down the vessel. This helps find areas of blockage in the blood vessels. Blockages may need only medications for treatment if they are not too tight. If they are severe enough to impede the blood flow to the heart muscle they may need either a stent or bypass surgery.

Cardiac catheterization also involves measuring pressures in the different chambers of the heart.

Depending on your symptoms and presentation you may need either an elective procedure on a predetermined date and time or an emergent procedure with admission to the hospital.

Though you are awake during the procedure, you are given sedatives. You are also given a numbing injection in the groin or wrist where the catheter is place. Though you may be allowed to go home the same day, you will need a ride home. You may be asked not to do any heavy lifting for a few days.

There is a small risk of complications, mostly involving bleeding at the groin or wrist.

Radial Artery Catheterization

Traditionally the femoral artery (groin approach) has been used for cardiac catheterization to look at the blood vessels supplying the heart. Radial approach (through the wrist) is now gaining popularity both with doctors trained to perform it as well as with patients.

The femoral artery is large and gives direct access to the heart, but it comes with a price. Patients have to lie in bed for 2-6 hours after the procedure without bending their leg. This may be particularly difficult for patients with back pain. It also has a higher chance of causing bleeding, both internal and external. Sometimes this requires giving patients blood transfusions and rarely needs surgery to repair the femoral artery.

The radial artery is superficially located in the wrist. It does not have space to bleed internally and external bleeding can be easily compressed. Hence this approach is safer.

From the patient’s viewpoint, radial approach is more comfortable because they can sit up immediately after the procedure.

All patients planned for radial approach to cardiac catheterization undergo a bedside test to see if they would be safe candidates for the radial approach. There are a few complications, like with other invasive procedures. The radial artery is smaller than the femoral artery and can spasm during the procedure. This can be treated with relaxing medication for the blood vessel. After the procedure there is a small risk that the radial artery could clot but because of redundant supply to the hand most patients have no symptoms.

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